UKESAD: Delegate Booking Form

9th UK/EUROPEAN SYMPOSIUM ON ADDICTIVE DISORDERS
Central London, by the Tower of London
10, 11, 12 May 2012.

Meet friends, make friends, learn,
earn 27 CEUs.

Simply fill in the form below to ensure delegate entry to UKESAD.
Call 020-7233 5333 or email info@ukesad.org if you have any queries.

* the subsidised rate for voluntary organisations is £154/day or £375 for 3 days
* the rate for public/private-sector organisations is £195/day or £425 for 3 days.

EARLY-BIRD DISCOUNT SAVES YOU £100!
Simply pay by 23 January 2012
Only £275 for all 3 days (voluntary organisations)
Or £325 for public/private-sector organisations.
Thanks to the generosity of our sponsors, this is less than cost price.

We can email you an invoice specific to your requirements with details of how to pay by cheque, card or online.

9th UK/EUROPEAN SYMPOSIUM ON ADDICTIVE DISORDERS
Central London, by the Tower of London
10, 11, 12 May 2012.

Contact Details

First Name *

Last Name *

Title (e.g Mr, Ms, Mrs etc) *

Job Title *

Telephone (including code) *

Email (booking confirmation will be sent here) *

Organisation *

Organisation Type *

Contact Address

Address Line 1 *

Address line 2

Town/City *

County/State *

Postal Code *

Country *

When will you attend? *

Payment Details

Purchase order no. (if applicable)

Invoice Address (If different from above)

Address Line 1

Address line 2

Town/City

County/State

Postal Code

Country

Any special access requirements?

Any special dietary requirements?

Additional Comments

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